1467414896 NPI number — DR. SIMON MUAKA NZUZI DPM

Table of content: DR. SIMON MUAKA NZUZI DPM (NPI 1467414896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467414896 NPI number — DR. SIMON MUAKA NZUZI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NZUZI
Provider First Name:
SIMON
Provider Middle Name:
MUAKA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NZUZI
Provider Other First Name:
BERNADETTE
Provider Other Middle Name:
NTOYA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467414896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12118 LAURELTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11422-1047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-410-8069
Provider Business Mailing Address Fax Number:
212-410-8440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20507 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
HOLLIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-479-7993
Provider Business Practice Location Address Fax Number:
212-410-8440
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  NOO3037 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213EP1101X , with the licence number: N003037 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: N003037 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0046447 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: #0276134 . This is a "CIGNA-MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 115, 119, 65 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MPI:28980 . This is a "UNITED HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SP13669 . This is a "CENTER CARE PROVIDER NUMB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0047963 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 396200P . This is a "HIP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0029644 P-64 P110 . This is a "OXFORD PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P34003SN . This is a "BLEU CROSS/BLEU SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P.3037-0 . This is a "WORKER-COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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